2017, Vol 15, No 1
Recommendations of the Polish Gynecological Oncology Society for the diagnosis and treatment of ovarian cancer
Curr Gynecol Oncol 2017, 15 (1), p. 5–23
DOI: 10.15557/CGO.2017.0001
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Recommendations of the Polish Gynecological Oncology Society for the diagnosis and treatment of cervical cancer
Curr Gynecol Oncol 2017, 15 (1), p. 24–33
DOI: 10.15557/CGO.2017.0002
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Recommendations of the Polish Gynecological Oncology Society for the diagnosis and treatment of endometrial cancer
Curr Gynecol Oncol 2017, 15 (1), p. 34–44
DOI: 10.15557/CGO.2017.0003
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Recommendations of the Polish Gynecological Oncology Society for the diagnosis and treatment of vulvar cancer
Curr Gynecol Oncol 2017, 15 (1), p. 45–53
DOI: 10.15557/CGO.2017.0004
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Analysis of treatment failures in stage IB–IIA squamous cell carcinoma of the uterine cervix following surgery
Curr Gynecol Oncol 2017, 15 (1), p. 54–67
DOI: 10.15557/CGO.2017.0005
ABSTRACT

The outcomes of cervical cancer treatment are strictly associated with such prognostic factors as tumor size, the presence of metastases in pelvic lymph nodes, parametrial invasion and tumor differentiation grade. The aim of the study was to analyze the outcomes of 338 patients with FIGO stage IB–IIA cervical cancer treated with surgery at the Oncology Center in Bydgoszcz, Poland, in 2002–2015. Statistically significant differences in the overall survival rates depending on the size of cervical tumor and FIGO stage as well as in recurrence-free survival rates depending on the presence of pelvic lymph node metastases were observed. In 29.3% of patients treatment failure occurred. In 54.5% of patients from this group nodal recurrence was found and in 26.3% of patients central recurrence was observed. Median time to nodal recurrence was 14 months and median time to local recurrence was 13 months. The results of the analysis confirm the impact of the status of pelvic lymph nodes and the size of the primary tumor on the prognosis for cervical cancer patients.

Keywords: squamous cell carcinoma of the uterine cervix, radical hysterectomy, cervical cancer recurrence, stage I–IIA cervical cancer treatment outcomes
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Cervical adenocarcinoma managed with surgery – prognostic factors and treatment outcomes
Curr Gynecol Oncol 2017, 15 (1), p. 68–77
DOI: 10.15557/CGO.2017.0006
ABSTRACT

Aim of the study: Analysis of prognostic factors and treatment outcomes in patients with adenocarcinoma of the cervix treated by surgery. Material and methods: Data of 120 cervical adenocarcinoma patients treated in years 1985–2007 at the Department of Gynecologic Oncology of the Cancer Center, Division in Krakow were analyzed in detail. All patients were treated with primary surgery. The results of combination therapy were evaluated at the first follow-up appointment (6 weeks – 3 months) after completing adjuvant radiotherapy, based on a clinical examination and imaging tests. Progression-free survival and the 5-year survival rate were assumed as the criteria to evaluate the effectiveness of therapy. Survival probability was calculated with Kaplan–Meier estimate. Peto’s log-rank test was used to determine the statistic significance of the obtained differences, and the Cox hazard model was applied to assess the impact of given risk factors on patient mortality. Results: The 5-year survival rate in the group of 120 cervical adenocarcinoma patients was 74.3%. Thirty-two patients (26.6%) suffered a relapse. The average progression-free survival was 24.6 months, and median progression-free survival – 27 months. Multivariate analysis demonstrated a statistically significant detrimental effect of menopause, comorbidities, lymphovascular space invasion, and metastasis to pelvic lymph nodes on overall survival. Conclusions: Primary surgery is an effective method of treatment for patients with stage IA and IB cervical adenocarcinoma. Multivariate analysis showed a negative impact on overall survival of the following factors: menopause, comorbidities, lymphovascular space invasion, and metastasis to pelvic lymph nodes.

Keywords: cervical cancer, radiotherapy, surgery
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Antiangiogenic therapy in ovarian cancer – for whom and when?
Curr Gynecol Oncol 2017, 15 (1), p. 78–85
DOI: 10.15557/CGO.2017.0007
ABSTRACT

Tumor angiogenesis appears to be an important process in epithelial ovarian cancer development. Bevacizumab is a monoclonal antibody that can neutralize vascular endothelial growth factor, a promoter of the initiation phase of angiogenesis. First-line chemotherapy in combination with bevacizumab followed by maintenance bevacizumab demonstrated efficacy over chemotherapy alone in two phase III trials (Gynecologic Oncology Group, GOG 218 and ICON7); however, absolute progression-free survival benefit remains modest, with no demonstrated impact on overall survival. The addition of molecularly targeted agents to the treatment of women with recurrent and platinum-sensitive disease has been recently reported in the OCEANS study, which evaluated the benefit of adding bevacizumab to carboplatin and gemcitabine in women with platinum-sensitive recurrent disease. Bevacizumab-based therapy also extended progressionfree survival from 8 to 12 months. However, overall survival was not different between the two arms. In the Gynecologic Oncology Group 213 (GOG 213) trial, women with platinum-sensitive recurrent epithelial ovarian cancer were randomly assigned to medical treatment (carboplatin plus paclitaxel with or without bevacizumab). A significant improvement in progression-free survival (14 versus 10 months, respectively) was observed. A trend towards a significant improvement in overall survival, which was not statistically significant, was reported. In November 14, 2014, based on AURELIA findings, the Food and Drug Administration approved bevacizumab in combination with paclitaxel, pegylated liposomal doxorubicin, or topotecan, for the treatment of patients with platinum-resistant recurrent epithelial ovarian cancer. Ovarian cancer is a primary cancer against which these new agents are being tested. This review will describe the role of angiogenesis inhibitors in epithelial ovarian cancer.

Keywords: antiangiogenic agents, ovarian cancer, bevacizumab
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Current guidelines on the diagnosis and management of lobular carcinoma in situ
Curr Gynecol Oncol 2017, 15 (1), p. 87–90
DOI: 10.15557/CGO.2017.0008
ABSTRACT

Lobular carcinoma in situ of the breast is classified as non-invasive malignant tumor of the breast. Its diagnosis is a marker for an increased risk of developing other histological types of breast cancer. Lobular carcinoma in situ is usually asymptomatic, with no characteristic radiological features. The diagnosis is often accidental while diagnosing lesions found on screening mammography. The most important clinical issue associated with the diagnosis of lobular carcinoma in situ is the possible risk of concurrent breast cancer of another histological type. According to the current standards of managing patients with lobular carcinoma in situ of the breast, surgical biopsy of the mass is most commonly recommended. Specific principles of therapy depend on the circumstances surrounding the diagnostic process. The complete diagnosis requires histopathological study of tissue specimens from paraffin blocks. It is necessary to determine the histological subtype of the identified tumor as different subtypes present significant differences as to the course of the disease (classic lobular carcinoma in situ, pleomorphic, florid or comedo with necrosis ones). Contrary to the classic lobular carcinoma in situ, other subtypes are characterized by significantly higher risk of coexisting infiltrating breast cancer. In such cases, it is necessary to perform surgical excision of the tumor. Diagnosis of LCIS does not require surgical treatment (possible active surveillance of the patient).

Keywords: lobular breast cancer in situ, diagnosis and treatment, surgical treatment
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